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Biomedical subjects

J Duxbury

Publications and source records attributed to J Duxbury.

13 recordsLinked to original sources
PubMed2006

Aggressive behaviour by people with dementia in residential care settings: a review.

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.

Aged↗
PubMed2005

Low grade multiple myeloma that presented as a labial swelling -- a case report.

Myeloma is a disease of the bone marrow in which there is malignant proliferation of plasma cells. Myeloma is usually associated with the accumulation of a monoclonal immunoglobulin or light chains in plasma and subsequently an increase in light chains in the urine (Bence-Jones proteins). Renal failure can occur and bone destruction in the axial skeleton may ensue with pain and fractures. Amyloidosis associated with multiple myeloma is a relatively common finding. The most frequently reported oral sign of amyloidosis is macroglossia. There are numerous cases in the literature of amyloid deposition in tongues related to multiple myeloma. However, none of these cases describe amyloid deposition surrounding arteries in the oral cavity. We therefore report a case of an innocuous lower labial swelling, which subsequently led to the diagnosis of amyloid deposition surrounding an artery, the cause of which was later shown to be multiple myeloma.

Aged↗
PubMed2005

Patients treated by dental students in outreach: the first year of a pilot project.

This paper describes the patients treated by 4th year undergraduate students during the first year of a pilot outreach course to teach Restorative Dentistry in community clinics in 2001-02. Data were collected from 908 summaries of patient treatment completed by the students, and from 139 patient questionnaires. Some 75% of patients were aged between 16 and 64, 58% were female, and 16% had dental phobia or anxiety. Most lived locally to the clinic and 41% made their initial contact as an emergency or drop-in. Some 37% made only a single visit (including children treated as emergencies) but 22% made six or more visits. Did not attend (DNA) was a problem and 18% of patients DNA to complete their treatment. Students undertook the full range of restorative procedures, with the emphasis on direct restorations, preventive treatment and advice, scaling, extractions and emergency treatment. Patients' main reasons for attending the clinic were lay recommendation, the need for treatment, convenience, free treatment, or the lack of access to a dentist. Some 30% said they did not have or did not know of an alternative source of dental care, and half had not seen a dentist for at least 2 years. The study demonstrates that despite difficulties related to attendance, a suitable patient base can be established offering students the opportunity to provide comprehensive care for adults in a primary care setting.

Adolescent↗
PubMed2002

An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design.

Following an initial springboard study, a further more extensive piece of research was conducted to identify and evaluate approaches used to manage patient aggression and violence on three acute mental health wards. Data were gathered using an incident form, a questionnaire and interviews. The views of patients (n = 80), nurses (n = 72) and medical staff (n = 10) were explored. Findings revealed a clear distinction between the way staff and patients view both the problem and the response. Patients' view present staff approaches as 'controlling' and believe that environmental and poor communication factors underpin aggressive behaviour. Staff, conversely, attribute aggressive behaviour to internal patient and external factors, which may explain the reason for approaches used. A strong correlation was found between type of patient aggression and response (r = 0.36, P < 0.000) and a high percentage of incidents reported were of an aggressive, as opposed to violent, nature. For example 70% of incidents involved verbal abuse or threat. Despite this, 47% (n = 103) of approaches incorporated the use of medication, restraint or seclusion. These are commonly referred to as traditional methods. Patients clearly view this controlling style as a part of the problem and an emphasis upon control and symptom reduction may be inappropriate given the type of aggression encountered. Key issues were further analysed using an internal, external and situational model, each of which endeavour to explain reasons for patient aggression from different perspectives. It is this emphasis upon sole perspectives that may both contribute to and result in the use of a limited number of management approaches adopted in practice. The integration of all three models to examine the complex nature of patient aggression and violence from a variety of perspectives may be the way forward. As a result, approaches to deal with this problem could be more meaningful and subsequently effective.

Attitude of Health Personnel↗
PubMed1999

An exploratory account of registered nurses' experience of patient aggression in both mental health and general nursing settings.

Until relatively recently, aggression and violence in nursing has been an area of little discussion (Poster & Ryan 1993). Today, concerns are rising about escalating levels of violence towards nurses (Wykes 1994, Whittington 1997). In response, this paper explores registered nurses' experiences of patient aggression encountered in the acute inpatient general and mental health settings. Critical incidents from registered nurses in both areas are examined and analyzed in relation to existing literature. The aim of the research is to ascertain if differences exist or similarities prevail. Findings reveal that the two areas have similar problems in terms of types of aggression. Verbal and 'minor' types of aggression are the most problematic. Also, the 'biomedical model' of care is evident in both settings and possibly underpins chosen approaches to aggression management. The repeated use of chemical and physical restraint is apparent. The main comparison identified between the two groups relates to nursing control over situations involving violent patients. Mental health nurses seem to consistently take control of aggressive situations whilst general nurses tend to rely more heavily upon the input of others (medical staff, mental health teams and the police) when intervening. These two nursing specialties therefore have much to learn from each other in terms of nursing experience and possible future approaches to the management of aggressive patients.

Aggression↗
PubMed1996

The nurse's role as patient advocate for mentally ill people.

The recent report of the Confidential Inquiry into Homicides and Suicides by Mentally Ill People (the Boyd report) compiled for the government, and the imminent publication of the Mental Health Patient's Charter, highlight national concern over the provision of care for this group of people. This article examines some of the dilemmas facing mental health nurses when caring for patients under detention orders and evaluates guidelines and recommendations which can aid the nurse in providing appropriate care.

Commitment of Persons with Psychiatric Disorders↗
PubMed1994

An investigation into primary nursing and its effect upon the nursing attitudes about and administration of prn night sedation.

This study aims to explore the administration of prn night sedation by qualified night nurses on primary nursing and team nursing wards using a quasi-experimental design. The purpose of the study was to examine the attitudes of qualified nurses (n = 20) about sleep problems in hospital and sleep medication and compare these attitudes with behaviour (the administration of prn night sedation) reporting any differences between wards using team and primary nursing philosophies of care. Ten nurses from team nursing wards and 10 nurses from primary nursing wards were interviewed about the amount of night sedation they had administered during one night shift. This was followed by a questionnaire aimed at examining their attitudes about sleep and night sedation using several visual analogue scales. Findings proved to be significant in that results confirmed that team nurses gave out almost three times as much prn night sedation as nurses on primary nursing wards and held attitudes that closely correlated with more of a 'medical model' approach such as an emphasis on the advantages of night sedation and the need for its continued use in the clinical area.

Adult↗
PubMedDate not supplied

Avoiding disturbed sleep in hospitals.

The second article in our series on patients' sleep and night nursing explores the reasons why patients may have difficulty in sleeping in hospital. The author looks at the various definitions and classification of insomnia and identifies the most likely causes of a disturbed night's sleep in hospital.

Humans↗
PubMedDate not supplied

Night nurses: why are they undervalued?

This is the last article in our series of three looking at sleep in hospitals and the role of the night nurse. This article discusses why night nurses sometimes feel they are undervalued and unappreciated by the nursing profession. The application of primary nursing is also reviewed and presented as a possible solution to the overroutinisation of night nursing.

Humans↗
PubMedDate not supplied

Night nursing. Understanding the nature of sleep.

This is the first article in a series of three looking at patients' sleep in hospitals. This article explores the nature of sleep and reviews the various theories that have been put forward to explain why we need to sleep. The other two articles will concentrate on sleep disorders and hospitalisation, and the role of the night nurse.

Humans↗